More Transparency Could Help Fight Fraud and Strengthen Medicare

by Gavin Baker, 9/6/2013

On Sept. 5, the Center for Effective Government, along with 13 other organizations, filed comments calling for the disclosure of Medicare payments to medical providers. Releasing the amounts of Medicare funds paid to providers could help fight fraud and strengthen Medicare.

As we’ve written previously, a 1979 court injunction prevented the government from releasing data on payments to Medicare providers, under the theory that disclosing the amounts would violate the providers’ privacy. In May, though, the court lifted the injunction, allowing the government to consider anew whether it could release the data. In August, the Centers for Medicare & Medicaid Services (CMS), which administers Medicare, asked for public comment on whether, and how, it should release the data.

The public has a fundamental right to know how government spends public funds. Medicare’s tremendous size and impact – $555 billion in expenditures, covering 49 million beneficiaries – make it a prime target for increased transparency. In fact, just the improper payments from Medicare are estimated at a whopping $44 billion – which is more than the entire budget for the Justice Department.

Releasing payment data would allow members of the public, including journalists and watchdogs, to help detect fraud or improper payments. That increased scrutiny could deter fraudsters– as happened with spending under the 2009 Recovery Act. This in turn could strengthen Medicare and help ensure its ability to continue playing its vital role in securing health care for America’s seniors.

And the arguments against releasing the data just don’t hold water. Medical providers, as businesses, don’t have a privacy interest in how much public money they receive from the federal government. Providers of other services and products already have their receipt of federal funds disclosed on USAspending.gov; medical practices should be not be treated any differently. Of course, we should protect the privacy of patients – but knowing how much Medicare pays providers wouldn’t threaten that.

CMS should take these perspectives into account and establish a new policy providing for greater transparency. And Congress has also taken notice of the situation – the Medicare Data Access for Transparency and Accountability Act, which has been introduced in both the Senate and House, would require the payment data to be disclosed.